Federal health officials are continuing to warn consumers to not eat romaine lettuce from Salinas, California.
More than 100 people in 23 states have been infected with a strain of E. coli linked to romaine lettuce harvested in the California growing region, the Centers for Disease Control and Prevention announced Wednesday.
The CDC said in an update that an additional 35 illnesses have been reported since Nov. 26 when there were 67 cases in 19 states.
The Food and Drug Administration and the CDC are investigating a multistate outbreak of E. coli O157:H7 infections linked to the lettuce "to determine the source of contamination and if additional products are linked to illness."
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The outbreak has grown from when health officials put out a safety alert Nov. 22 warning consumers to not eat romaine lettuce from the California region from stores across the nation, and for restaurants to not serve the lettuce.
In an update Wednesday, the FDA said it "requested that industry voluntarily withdraw romaine grown in Salinas from the market and is requesting that industry withhold distribution of Salinas romaine for the remainder of the growing season in Salinas. Without more specific traceback information, this was the most efficient way to ensure that contaminated romaine was off the market."
The CDC is advising consumers to not eat – and retailers not to sell – the lettuce harvested in the California region, including "whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix and Caesar salad." This includes all use-by dates and brands from Salinas.
According to the FDA, "romaine lettuce that was harvested outside of the Salinas region has not been implicated in this outbreak investigation."
"Hydroponically- and greenhouse-grown romaine, which is voluntarily labeled as 'indoor grown,' from any region does not appear to be related to the current outbreak," the FDA said in a statement. "There is no recommendation for consumers or retailers to avoid using romaine harvested from these other sources."
The illnesses started Sept. 24, and cases have been reported through Nov. 18, the CDC said. The ages of those sickened range from 1 to 89, with a median age of 25.
A total of 58 hospitalizations have been reported, and 10 people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported, according to the CDC.
Wisconsin has the most cases with 31, up from 21 previously reported, followed by Ohio with 12.
Pennsylvania had eight cases, New Jersey had seven, Colorado had six, and four states had four cases, California, Maryland, Texas and Virginia.
Arizona, Idaho and Minnesota had three cases with New Mexico and Washington having two cases a piece.
The following nine states had one reported case each as of the Wednesday report: Florida, Illinois, Iowa, Michigan, Montana, Nebraska, North Carolina, Oregon and South Dakota.
E. coli symptoms vary and can include abdominal cramps, nausea, fatigue and diarrhea. Symptoms usually begin within three to four days after eating items containing the bacteria. However, the CDC states that symptoms can start anywhere from two to eight days "after swallowing the germ."
Follow USA TODAY reporter Kelly Tyko on Twitter: @KellyTyko
This article originally appeared on USA TODAY: E. coli outbreak: 102 sick from Salinas, California romaine lettuce